Derm

Question 1

what is the pic showing

Answer 1

acrochordons → skin tags

Question 2

pruritic lesion, tan to brown, waxy, stuck on appearance

Answer 2

seborrheic keratosis

Question 3

asymptomatic papule, dimpled on either side when squeezed

following inflamed hair follicle

Answer 3

dermatofibroma

Question 4

brown papule around eyes and malar cheeks

genetic

AA

Answer 4

dermatosa papulosa nigra

Question 5

tx for dermatosis papulosa nigra least likely to cause hypopigmentation

Answer 5

liquid nitrogen

Question 6

scattered light brown macule on dorsal hands and face

increasing in number, otherwise unchanged

dog walker in LA

Answer 6

solar lentigines

Question 7

major criterion for neurofibromatosis (NF) 1 and important finding to look for on PE when screening pt’s

Answer 7

axillary freckling

Question 8

pt’s w. neurofibromatosis 1 need to be followed closely for

Answer 8

development delays/learning disabilities

Question 9

reddish papules on nose, chin, medial cheeks and small, scattered hypo pigmented macule

what PE finding would suggest tuberous sclerosis

Answer 9

dental enamel pits

gingival fibromas

larger hypopigmented macules

periungal fibromas

Question 10

newborn w. 5 hypopigmented birthmarks 1-2 cm

tuberous sclerosis is suspected via genetics testing

how do you manage

Answer 10

baseline MRI of brain and EEG dt CNS involvement and sz potential

MRI of brain at dx and q 1-2 years after in asymptomatic pt < 25 yo

and baseline EEG

Question 11

pt w. Sturge Weber syndrome can have __ associated w. capillary malformations

Answer 11

soft tissue overgrowth

dt GNAQ mutation

Question 12

capillary malformations (port wine stains) can be associated w. leptomeningealangiomatosis and sz in setting of sturgeon weber syndrome (SWS)

what is recommended for management

Answer 12

urgent refer to ophthalmology to screen for glaucoma

Question 13

7 yo w. 2 months of hair loss w. scaling in a few small patches

how do you dx

Answer 13

fungal culture

Question 14

10 yo boy has patches of hair loss of different lengths

parents cut hair so he’ll stop pulling

most likely dx?

Answer 14

trichotillosis

Question 15

30 yo woman has 2 patches of hair loss that shed suddenly - a few hairs grow w.in them

there is no scale and skin feels smooth

what do you tell her about prognosis

Answer 15

hairs will likely regrown on their own w.in 6-12 mo

Question 16

35 yo woman w. normal menstrual periods c.o sudden hair loss throughout cal over past few weeks

not getting much sleep w. 6 mo old breastfeeding through the night

she notices ore hairs in drain and in shower and on hairbrush

most likely cause?

Answer 16

pregnancy/delivery

Question 17

58 yo woman complains of gradual hair loss starting on top of scalp

worried about balding

rec for tx?

Answer 17

topical minoxidil

Question 18

45 yo woman c.o gradual loss of hair on front of scalp w, similar change on sides

what do you recommend to prevent further hair loss

Answer 18

wear hair in natural, non pulling styles

Question 19

36 yo woman w. 1 year of progressive hair loss

she notices scaling around follicles w. tender sensation, shiny scalp, w.o hair follicles in patches

course of action?

Answer 19

referral to derm

Question 20

43 yo presents for eval of white spots on tongue that have ben present for at least 1 mo

not painful or itchy, don’t bleed - no fever or pain w, swallowing

PMH: HIV, has not been taking meds - most recent CD4 was 152

PE: white corrugated plaques on lateral margins of tongue - can not be scraped off

what causes these lesions

Answer 20

epstein-barr infxn

typical distribution: lateral tongue

mc in smokers

Question 21

28 yo w. 6 mo hx of bumps in anal area - sometimes itchy w. bleeding

transgender w. assigned male natal sex

smokes daily, multiple sex partners - unprotected anal ex

has been treated for both syphilis and gonorrhea in the past

PE: soft, verrucous vegetative, exophytic plaques from anal verge, no genital lesions

next step?

Answer 21

serum HIV and RPR

given extensive condyloma and lifestyles, need to r.o HIV and syphilis reinfection

condyloma lata of syphilis can mimic HIV induced condyloma.warts

Question 22

previous pt is HIV (+) w. CD4 75 - she is on ART

bx shows condylaoma and squamous intraepithelial lesion w. high risk orogenic HPV detected on in situ hybridization

you start ablative tx w. topical imiquimod - she continues to be concerned about nonspecific anal pain, tenesmus, and rectal bleeding

what is the next step?

Answer 22

refer for anal typology or high res anoscopy

Question 23

29 yo w. hx etoh abuse - asymptomatic purplish lesions on palms/soles/legs x a few weeks

sore spot on penis a few months ago

sexually active both men and women w.o protection

what do you do next

Answer 23

serum RPR and HIV

Question 24

34 yo woman - diffuse itchy rash x 3 weeks

started on chest and shoulders, spread to back, and, arms/legs - mildly pruritic

recent dx HIV

PE: erythematous plaques w, trace overlying scale on trunk, shoulders, thighs/extremities - no mucosal involvement - afebrile

next step?

Answer 24

reassure this is benign dt drug rxn

prescribe short course of triamcinolone for sx relief

Question 25

3 day old male - 24 hr hx small white-yellow papule and pustules w. erythematous botchy skin areas involved: face, trunk, extremities swab from pustule shows numerous eosinophils pt afebrile and healthy most likely dx?

Answer 25

erythema toxicum neonatorum common erythematous macule/papules that rapidly progress to flaccid pustules on erythematous base pustules loaded w. eosinophils

Question 26

18 day old female w. 5 day hx of red pimples on both cheeks dx: neonatal acne mom is breastfeeding and concerned that her diet could be affecting baby what do you tell her?

Answer 26

neonatal acne is result of inflammatory rxn to pityrosporum (malassezia) species - self limiting condition that doesn't require tx

Question 27

female newborn w. widespread rash involving face, trunk, extremities lesions: pustules and hyper pigmented macules w. discrete scaling: transient neonatal pustular melanosis you perform a swab - what will you find on the smear

Answer 27

numerous neutrophils and negative gram stain

Question 27

female newborn w. widespread rash involving face, trunk, extremities lesions: pustules and hyper pigmented macules w. discrete scaling: transient neonatal pustular melanosis you perform a swab - what will you find on the smear

Answer 27

numerous neutrophils and negative gram stain

Question 28

5 day old in NICU for fever and blisters/vesicles - neonatal herpes which is NOT useful to confirm

Answer 28

testing mom

Question 29

useful tests for neonatal HSV

Answer 29

HSV antigen w. rapid immune fluorescence assay or enzyme assay HSV PCR from surface site or CSF culture Tzank smear

Question 30

10 day old baby boy w. multiple reddish brown papules and nodules at different sizes - some w. crusting on scalp/face/trunk and diaper area - some look petechial afebrile, otherwise healthy most likely dx

Answer 30

langerhans cell histiocytosis

Question 31

4 mo old has cradle cap since birth w. several erythematous plaques and greasy scales on scalp and retro articular areas w. excoriation 2/2 to scratching mom uses organic baby shampoo how do you manage

Answer 31

**seborrheic dermatitis** low potency topical steroids and petrolatum or mineral oil

Question 32

49 yo woman admitted w. fever/dyspnea - treated for pan complicated by uncontrolled dm on day 7 she developed bright red itchy spots on both legs but was afebrile and ready for d/c most likely dx?

Answer 32

leukocytoclastic vasculitis from abx

Question 33

43 yo diabetic male in ED for 6 hr of very painful rapidly growing red/purple plaque on left thigh - started w. follicle/boil near site of insulin injxn center has small erosion and is darker than surrounding tissue pt has been waiting for an hour and redness has grown ~ 1 cm and is tender what do you do

Answer 33

urgent surgery referral

Question 33

43 yo diabetic male in ED for 6 hr of very painful rapidly growing red/purple plaque on left thigh - started w. follicle/boil near site of insulin injxn center has small erosion and is darker than surrounding tissue pt has been waiting for an hour and redness has grown ~ 1 cm and is tender what do you do

Answer 33

urgent surgery referral

Question 34

50 yo male c.o severe itching and redness on both legs x several weeks w. weeping he is afebrile and uses moisturizers or OTC remedies bid no hx swelling most likely dx

Answer 34

allergic contact dermatitis

Question 35

42 yo woman c.o redness and pain on left thigh x 2 days - odd shape moving up leg - blister in the center - afebrile most likely dx

Answer 35

cellulitis

Question 36

52 yo f - several days of itching, redness, tightness on both lower legs - legs swell during the day - relieved w. sleeping - afebrile dx?

Answer 36

stasis dermatitis

Question 37

consult for new rash on 16 yo girl w. lesions scattered on legs - described as dark purple patch w. overlying vesicle that does not fade when pressed on most appropriate morphologic term for finding

Answer 37

purpura fulminant

Question 38

same pt as last card - lesions scattered on legs - confirmed petechiae and ecchymosis on bilateral legs that stop at waist mild abd pain, fatigue, myalgia, arthralgia platelets: 165, BP 106/82 most likely cause?

Answer 38

leukocytoclastic vasculitis from henoch schonlein purpura IgA driven after respiratory/urinary infxn

Question 39

28 yo woman w. scattered red macule on legs, ankles, and feet no panful or itchy next step in dx?

Answer 39

diloscopy to see if they blanch

Question 40

7 yo boy in urgent care w. abd pain, joint aches, rash on legs/feet no hx nose bleeds or bruising or bleeding most likely dx

Answer 40

hence schonlein purport

Question 41

38 yo m w. hx Crohn's recently tx w. azathioprine and prednisone - he was well until 3 days ago when he developed worsening abd pain no recent sick contacts or travel he has somnolence, fever, abd pain, new rash t: 102.1, HR: 117, RR: 14, BP: 86/54 most likely cause of purpuric rash?

Answer 41

sepsis

Question 42

69 yo f - increase in marks on forearm x 1-2 months - otherwise well except for pain in knees dt OA takes hydrochlorothiazide for HTN, naproxen bid, MV next step in management

Answer 42

reassurance

Question 43

32 yo w. hives x 8 weeks - no new meds not painful, no pigmentation or other marks no respiratory sx or lip/tongue swelling - does not want to take meds tat make her sleepy what med do you recommend

Answer 43

loratidine

Question 44

27 yo f w. hives on neck, trunk, proximal extremities - pruritic and resolve w.in 1 day how do you manage te

Answer 44

testing not necessary at this time

Question 45

25 yo woman - itchy intermittent welts all over body that last 1 day topical hydrocortisone does not help best first line tx?

Answer 45

antihistamines

Question 46

cardinal sx of urticaria

Answer 46

hives, Pruritis, itchiness

Question 47

62 yo man w. urticaria x 3 years has been tested for allergies - all negative mc cause

Answer 47

idiopathic

Question 48

what is most potent tx for urticaria

Answer 48

first gen antihistamines

Question 49

9 yo m eats iced cream w. peanuts and develops erythematous wheals on lips/face/trunk slight wheezing, not taken to hospital and felt better w.in 1 hr fam comes in for tx several weeks later what do you recommend

Answer 49

epic pen w. instructions on how/when to use

Question 50

23 yo w. chronic urticaria x 2 years has tried second gen antihistamines w. only partial relief concerned about daytime sedation what do you recommend

Answer 50

first gen antihistamine taken in the evening